1083058424 NPI number — AT HOME PARTNERS

Table of content: (NPI 1083058424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083058424 NPI number — AT HOME PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME PARTNERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083058424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16692
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30321-0692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-698-1732
Provider Business Mailing Address Fax Number:
404-698-1732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4725 WALTON XING SW
Provider Second Line Business Practice Location Address:
5309
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30331-6279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-698-1732
Provider Business Practice Location Address Fax Number:
404-698-1732
Provider Enumeration Date:
04/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MUNGIN
Authorized Official First Name:
NYARKO
Authorized Official Middle Name:
O
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
404-698-1732

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN220068 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: LPN044213 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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